Case Of Reactive Arthritis Research Articles

THE EPIDEMIOLOGICAL CHARACTERISTIC OF DISEASES OF MUSCULOSKELETAL SYSTEM

The purpose of the study. To analyze prevalence of diseases of musculoskeletal system in the Arkhangelsk region. The methods. The data of official statistics was used to implement analysis of general morbidity of main diseases of musculoskeletal system of adult population the Arkhangelsk region during 2010-2015 as compared with corresponding morbidity in the North-Western Federal and the Russian Federation in general. The results. In the Arkhangelsk region, among general morbidity percentage of diseases of musculoskeletal system made up to 4.2% (7th rank). The increasing of common morbidity of diseases of musculoskeletal system in adult population was marked in the Arkhangelsk region up to 14% and in the Russian Federation up to 7%. Since 2010, in the Arkhangelsk region the study established increasing of common morbidity rheumatoid joint inflammation up to 22%, spondylopathy up to 65%, osteoarthrosis up to 32.4%, osteoporosis up to 46% and systemic diseases of connective tissue up to 11.5% surpassing average Russian indices. At that, number of cases of reactive arthritis decreased up to 17.2% Conclusions. In the Arkhangelsk region, the register of diseases of musculoskeletal system on the basis of region rheumatological center is to be developed to implement an objective assessment in the existent situation.

Evolving patterns of reactive arthritis.

To characterize rheumatologists' perspectives on evolving trends of reactive arthritis (ReA). After ethics approval, 548 members of the Canadian Rheumatology Association were surveyed with 37 questions covering their demographic information, subspecialty, level of experience, practice setting and opinions on prevalence, treatment, and causes of ReA. Results were analyzed with descriptive statistics. Ninety-seven responded to the survey (18% response rate); 66 fully completed it. Nearly half of respondents believed that the incidence of ReA is declining and causes of ReA may be changing. Physicians reported that most of the ReA cases in their practices were caused by an unknown organism, sexually transmitted, or gastrointestinal infection. Full triad ReA increased the chance of recurrence according to their impressions. Common investigations in ReA included inflammatory markers, HLA-B27, chlamydia and gonorrhea testing, stool cultures, synovial fluid analyses, SI joint imaging. ReA treatment included NSAIDs, intra-articular corticosteroid injections, and DMARDs. Two-thirds said they used TNF alpha inhibitors in chronic ReA occasionally or more frequently. ReA may be decreasing in frequency and severity in Canada. Changes could be due to less food borne illness, cleaner water, or more rapid treatment of sexually transmitted infections. The cause is often unknown in clinical practice.Key Points• Reactive arthritis (ReA) is likely decreasing in prevalence and severity.• Patients with classic trial of arthritis, urethritis, and conjunctivitis are more likely to have recurrent and/or chronic ReA.• The causal organisms are often not detected and seem to be changing over time.

Panorama of inflammatory arthropathies in rheumatologic consultations in Northern Togo.

To determine the frequency and epidemiological profile of inflammatory arthropathies seen during rheumatologic consultations in Togo. This retrospective study examined the records of patients with inflammatory arthropathy seen at a rheumatologic consultation at Kara Teaching Hospital (Northern Togo) over a four-year period. Among the 2361 patients with rheumatic disorders, 152 (6.43%) had an inflammatory arthropathy: 57.24% were men and 42.76% women. The main causes observed were: chronic inflammatory rheumatism (CIR) and connective tissue disease (49.34%), infectious arthritis (26.32%), and gout (24.34%). The mean age of the 75 patients with CIR at the onset of the disease was 40 years and the average duration of evolution was 3.11 years. The main clinical forms of CIR were rheumatoid arthritis (11 cases), spondylarthropathies (20 cases within 11 cases of reactive arthritis), connective tissue diseases (4 cases), and unclassified CIR (31 cases). Nine patients with reactive arthritis were HIV positive. The infectious arthritis was caused by a banal germ in 31 cases and by Koch bacillus in nine other cases. Gout patients (35 men and 2 women) had a mean age of 43 years at the onset of the disease, and the mean duration of the disease was 4.1 years. Gout was monoarticular in 8 cases, oligoarticular in 19 cases and polyarticular in the other 10 cases. This study demonstrates the high incidence of chronic inflammatory rheumatism in Northern Togo.

A controlled survey of less typical long-term consequences after an extensive waterborne epidemic

BackgroundExtensive backflow of treated wastewater caused household water contamination in a Finnish town in 2007. The drinking water of 9 500 residents became heavily polluted with faecal microbes, resulting in a large gastroenteritis epidemic. Cases of reactive arthritis, milder joint symptoms and prolonged gastrointestinal symptoms were observed after the outbreak. A follow-up survey was performed to study less familiar long-term health consequences within a year from the outbreak.MethodsThe contaminated group comprised a sample of residents of the area with polluted water supply (N = 323) and the control group a sample of residents in a nearby municipality (N = 186). The presence of 20 general symptoms or complaints was inquired by a mail survey. Quarterly prevalence of each symptom or complaint was measured. Twelve of these proceeded to further analysis.ResultsThe response rate was 53% (323/615) in the contaminated group and 54% (186/343) in the control group. Rash, eye irritation, heartburn and weight loss were more prevalent in the contaminated group during the first year quarter. In the last year quarter, only eye irritation was significantly more common in the contaminated group.ConclusionThe excess prevalence of four complaints at the first year quarter can be explained by acute gastroenteritis or intensive water chlorination. The excess prevalence of eye irritation at the fourth year quarter cannot be explained by chlorination anymore but might be a sign of co-existing reactive joint disease. In general, long-term consequences of the outbreak can be considered minor in terms of the surveyed symptoms or complaints.

Arthrite réactionnelle à Clostridium difficile : à propos de deux observations et revue de la littérature

Reactive arthritis due to Clostridium difficile infection is uncommon. We report two cases of reactive arthritis associated with C.difficile infection that occurred in a 40-year-old woman and a 47-year-old man. The literature review between 1976 (date of first reported case) and 2016retrieved 54observations (including our two cases). Reactive arthritis occurs most frequently in young subjects after a variable time frame according to C.difficile infection, involving one or several articulations. The issue is generally favourable with or without anti-inflammatory treatment. The increasing incidence of C.difficile infection makes more likely the occurrence of this related reactive arthritis. Therefore physicians should consider it in differential diagnosis of bacterial infections capable of causing reactive arthritis.

ANALYSIS OF THE INCIDENCE OF RHEUMATIC DISEASES IN THE ARKHANGELSK REGION: TRENDS IN THE 2010–2015 STATISTICAL CHARACTERISTICS

Objective : to investigate the incidence of acute rheumatic fever (ARF), chronic rheumatic heart disease (CRHD), musculoskeletal diseases (MSD), and connective tissue diseases in the pediatric and adult populations of the Arkhangelsk Region (AR) in comparison with the data on Russia and the North-Western Federal District (NWFD) in 2010–2015. Subjects and methods. The total and primary incidence rates of ARF, CRHD, and MSD were analyzed in the pediatric and adult populations of these regions in 2010–2015. Results and discussion. Among the adult population of AR, the total incidence of ARF was low (7 cases in 2010 and none in 2015), which is comparable with the data in the whole of Russia. No recurrences of ARF were registered in the AR. Among the adult population of AR, the total incidence of CRHD fell by 28% in 2010 to 2015. The similar trend was also observed in the whole of Russia. Patients newly diagnosed with CRHD decreased by 65% in the AR. There was a 14% increase in the total incidence of MSD among the adult population of AR and an 11% decrease in its primary incidence. Since 2010, the total incidence of rheumatoid arthritis (RA), osteoarthritis, spondylopathies (SP), osteoporosis (OP), and systemic connective tissue diseases rose in the AR. There were 22 and 140% increases in the incidence of RA and SP, respectively; the number of reactive arthritis cases decreased by 17.2% in the adults and increased by 7% in the children. This trend in the adults is seen of the whole of Russia (an 8% decrease), although the latter in the AR is not comparable to the All-Russian measures. In the AR, the incidence of OP remains low (50 and 73 per 100,000 population in 2010 and 2015, respectively); this is noted to increase by 46% in the past 5 years; the similar trend was observed in both the whole of Russia and NWFD (7.8 and 8.3%, respectively).

Reactive arthritis at the Sydney Sexual Health Centre 1992-2012: declining despite increasing chlamydia diagnoses.

Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992-2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992-2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992-1996 to one in 2007-2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992-1996 to 2257 in 2007-2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.04-10.32; p = 0.043) or born overseas (aOR 2.69; 95% CI 1.27-5.70; p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21; 95% CI 0.10-0.45; p < 0.001). Reactive arthritis was not associated with current or recent chlamydia infection (p = 0.184) but was marginally associated with past non-gonococcal urethritis (p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.

A new case of reactive arthritis following Yersinia pseudotuberculosis serotype IV

We report a case of post-yersinial reactive arthritis in a 4-year-old child. Three weeks after the onset of diarrhea, he developed tenderness of joints and bilateral conjunctivitis. Serological tests revealed antibodies to Yersinia pseudotuberculosis type IV. After a follow-up of 4 months, he has no complaints. Our recent case illustrates the typical features and highlights the need to look for the diagnosis.

Molecular pathological diagnostics of infections in orthopedic pathology

The diagnosis of infections in patients with arthritis and/or in joint prostheses requires interdisciplinary cooperation and the application of up-to-date methods. The histological investigation of the synovial membrane allows the differentiation of acute, chronic and granulomatous synovialitis. Detection of conserved regions of the microbial genome by PCR, especially 16S rRNA for bacteria and 18S rRNA for fungi, is a broad approach for the classification of pathogens which cannot be cultured. Acute infectious arthritis and periprosthetic infections share the spectrum of pathogens with sepsis, therefore multiplex PCR-based methods for the detection of sepsis can be employed. Molecular diagnostics can detect minimal infections in periprosthetic tissues even after antibiotic therapy. The anamnesis (enteral or urogenital infection), clinical picture (oligoarthritis) and further parameters (e.g. HLA B27 status) are important for the diagnosis of reactive arthritis. In many cases of reactive arthritis, molecular methods allow the detection of bacterial DNA or RNA in synovial fluid or tissue samples. The low sensitivity of histopathological methods may be compensated by application of PCR techniques, especially in the differential diagnosis of granulomatous synovitis including mycobacterial infections. Molecular methods can be used to support the differential diagnosis of septic and reactive arthritis. MicroRNA techniques combined with PCR for detection of pathogens support the differential diagnosis of rheumatoid arthritis with severe inflammatory activity compared to infectious arthritis. Proteomic methods could expand the methodological spectrum for the diagnosis of infections.

Disseminated Tuberculosis with Involvement of Appendix, Peritoneum and Right Knee Joint - A Case Report

A 27 year old male presented with painful swelling of right knee joint for the last 6 months. Initially it was diagnosed as a case of reactive arthritis and was treated with NSAID with intraarticular steroids without significant improvement. Two months after the initial episode he again developed painful swelling of the right knee joint with severe abdominal pain and high grade fever. There was an ill defined ovoid mass in the right iliac fossa with generalized tenderness. ESR was raised and the ultrasonography revealed loculated ascites with appendicular lump. CT scan of the whole abdomen showed appendicular lump. FNAC from the lump showed tuberculosis. Joint fluid aspiration showed neutrophilic leucocytosis with the Total count 50,000/cmm. AFB was not found. So septic arthritis was diagnosed, but as the patient was not improving we send the patient to orthopedic department for synovial biopsy but they refused as it was septic. So a diagnosis of disseminated Tuberculosis was made with the involvement of right knee joint, appendix and peritoneum. He was put on anti TB and well responded.DOI: http://dx.doi.org/10.3329/jom.v15i2.20702 J MEDICINE 2014; 15 : 153-155

Seroprevalence of campylobacteriosis and relevant post-infectious sequelae

Post-infectious sequelea such as Guillain Barré syndrome (GBS), reactive arthritis (RA), and inflammatory bowel disease (IBD) may arise as a consequence of acute Campylobacter-enteritis (AE). However, reliable seroprevalence data of Campylobacter-associated sequelae has not been established. The objectives of this study were, first, to identify the most specific and sensitive test antigen in an optimized ELISA assay for diagnosing a previous Campylobacter-infection and, second, to compare the prevalence of anti-Campylobacter antibodies in cohorts of healthy blood donors (BD), AE, GBS, RA, and IBD patients with antibodies against known GBS, RA and IBD triggering pathogens. Optimized ELISAs of single and combined Campylobacter-proteins OMP18 and P39 as antigens were prepared and sera from AE, GBS, RA and IBD patients and BD were tested for Campylobcter-specific IgA and IgG antibodies. The results were compared with MIKROGEN™-recomLine Campylobacter IgA/IgG and whole cell lysate-immunoblot. Antibodies specific for Helicobacter pylori, Mycoplasma pneumoniae, Yersinia enterocolitica, and Borrelia afzelii were tested with commercial immunoblots. ROC plot analysis revealed AUC maxima in the combination of OMP18 and P39 for IgA and in the P39-antigen for IgG. As a result, 34–49 % GBS cases, 44–62 % RA cases and 23–40 % IBD cases were associated with Campylobacter-infection. These data show that Campylobcater-seropositivity in these patient groups is significantly higher than other triggering pathogens suggesting that it plays an important role in development of GBS and RA, and supports the hypothesis that recurrent acute campylobacteriosis triggers IBD.

A rare case of reactive arthritis associated withEnterobius vermicularisinfection

A rare case of reactive arthritis associated with<i>Enterobius vermicularis</i>infection

Reactive arthritis associated with Mycoplasma genitalium urethritis

Mycoplasma genitalium is an important cause of sexually transmitted infections that is gaining recognition and is an independent cause of acute and chronic nongonococcal urethritis in men. M. genitalium has been implicated as a possible causative factor in reactive arthritis. We report a case of reactive arthritis complicating M. genitalium urethritis in an HLA-B27-positive patient.

Post-streptococcal Reactive Arthritis with Neuropsychiatric Syndrome in adult (A case report with brief review of literature)

We report a case of Reactive Arthritis with Neuropsychiatric Syndrome in an adult associated with Group A beta haemolytic streptococcal infection 1 . (Paediatric Acute Onset Neuropsychiatric Syndrome) is an immune mediated neuropsychiatric syndrome secondary to Group A beta haemolytic streptococcal infection which includes usually abrupt onset of obsessive-compulsive disorder, often pre-pubertal in onset, separation anxiety & abnormal movements during attack 2 . PANS is very common in children especially pre-pubertal age group. However the existence of neuropsychiatric syndrome as a post-streptococcal manifestation in adults is rare & long debated. There has been only one case report in the literature of post- streptococcal neuropsychiatric syndromes in adults 3,19 . We discuss the aspects of immune mediated post-

Reactive Arthritis in a Patient withChlamydia trachomatisInfection

The authors report a case of reactive arthritis that was caused by sexual contact as below example. A 36-year-old male visited our center due to sudden pain in wrist joint, the 3rd finger, knee joint, and achilles tendon. There were no specific abnormalities for the immunoserologic tests and magnetic resonance imaging; however, we found a positive test result for the polymerase chain reaction test of urine that identified Chlamydia trachomatis . Through considering the patient’s medical history and various examinations, we considered the possibility of reactive arthritis, to the exclusion of alternate diagnosis. According to the our diagnosis, the patient was treated with antibiotics and nonsteroidal anti-inflammatory drugs and we found that the patient was getting better. Therefore the authors think that we have to contemplate the possibility of reactive arthritis and treat appropriately in patients with similar symptoms.

Diagnóstico y tratamiento de la artritis relacionada con la infección por clamidia

La infección por clamidia del tracto urogenital es la más prevalente de las infecciones de transmisión sexual; sin embargo, el número de diagnósticos de artritis relacionada con clamidia se encuentra habitualmente muy por debajo de la incidencia estimada para la enfermedad. Esta situación podría estar relacionada con el alto porcentaje de infecciones previas asintomáticas y la ausencia de unos criterios diagnósticos adecuados. Los nuevos sistemas de detección de clamidia por medio de la reacción en cadena de la polimerasa (PCR) constituyen una de las técnicas más útiles para establecer el diagnóstico de esta patología. La terapia biológica plantea dudas teóricas en cuanto a su indicación y existe escasa información en cuanto a su eficacia en la artritis reactiva por clamidia. Aunque la utilidad del tratamiento antibiótico prolongado no está bien establecida, el tratamiento antibiótico combinado abre una nueva puerta al abordaje terapéutico de esta patología. Urogenital chlamydia infections are the most prevalent of all sexually transmitted diseases although the number of chlamydia-induced reactive arthritis cases are generally below the estimated incidence of the disease. This may be related with the high rate of asymptomatic chlamydial infections and the lack of adequate diagnostic criteria. Polymerase chain reaction (PCR), a new system for detection of Chlamydia, is one of the most useful techniques for the diagnosis of this disease. Biologic therapy produces theoretical doubts regarding its indication and there is little information related with chlamydia induced reactive arthritis treatment efficacy. Although the usefulness of long antibiotic treatment is not clear, the use of combination antibiotics opens new therapeutic strategies for chlamydia induced reactive arthritis.

Reactive arthritis induced by recurrent Clostridium difficile colitis

Clostridium difficile colitis is a common infection that can be difficult to resolve and may result in recurrent infections. Reactive arthritis is a rare presentation of this disease and its treatment is not well differentiated in the literature. We describe a case of reactive arthritis occurring in a patient with a history of recurrent Clostridium difficile colitis while currently receiving a taper of oral vancomycin. His arthritis symptoms resolved with corticosteroids and continued treatment with anticlostridial antibiotics.

Reactive Arthritis Associated With Proctitis Due to Chlamydia trachomatis Serovar L2b

We report the first case of reactive arthritis associated with lymphogranuloma venereum (LGV) proctitis in Australia. Since 2004, LGV proctitis has emerged as an important infection worldwide in men who have sex with men. While reactive arthritis is usually associated with serovars D to K of Chlamydia trachomatis, association with LGV serovars is historically rare. Screening for chlamydial infection should be considered in this group if they present with an acute arthritis otherwise the condition could go undiagnosed. Asymptomatic infections are being increasingly reported in Europe and prolonged treatment is required to ensure a cure.

A case of reactive arthritis successfully treated by tonsillectomy

A case of reactive arthritis successfully treated by tonsillectomy

Successful use of Etanercept for the treatment of Reiter’s syndrome: a case report and review of the literature

The treatment of severe and refractory cases of reactive arthritis is not well defined. There is a limited data about the use of tumor necrosis factor-α (TNF-α) blockers in reactive arthritis. Herein is a description of a patient with severe case of Chlamydia trachomatis-related reactive arthritis that was refractory to nonsteroidal anti-inflammatory drugs, sulfasalazine, prednisone, and methotrexate and was successfully treated with etanercept.